Natural Environment Intervention for Young Children with Autism

1. Natural Environment Intervention for Young Children with Autism Debra Leach, Ed.D., BCBA Winthrop University leachd@winthrop.edu 803-323-4760

2. Outline • Overview of NEI • NEI for Young Children with ASD • Ten Steps for Implementing NEI with Children with ASD and Their Families

3. Overview of Natural Environment Intervention (NEI) • NEI systematically maximizes teaching and learning opportunities throughout the day using naturally occurring routines and activities • Everyday routines and activities provide young children with many different kinds of learning opportunities (Raab & Dunst, 2004; Tomlin, 2002; Dunst, Hamby, Trivette, Raab, & Bruder, 2000; McWilliam, 1999) • When children are actively engaged in everyday routines and activities, they have multiple opportunities to practice existing abilities and acquire new skills • By receiving training and support from professionals, primary caregivers can provide effective intervention embedded within the context of daily routines and activities • Table 1 provides a comparison between tradition service delivery models and NEI

4. NEI for Young Children with ASD • The most important aspect of NEI is increasing the child’s active participation across a variety of activities • NEI can overcome motivation and generalization difficulties that often arise when implementing therapeutic intervention programs such as DTT and other applications of ABA • However, the ABA conceptual framework can and should be applied during NEI for children with ASD • Kashinath, Woods, and Goldstein (2006) showed positive results of NEI with children with ASD using behavioral interventions, but more research is needed

5. Implementing NEI with Children with ASD and Their Families • Provide an overview of NEI to caregivers • Assess strengths and interests • Assess present abilities • Assess caregiver priorities • Assess daily routines and activities • Conduct observations • Set goals • Provide training and coaching • Collect and analyze data • Continuous data-based decision making

6. Provide an Overview of NEI to Caregivers • Early intervention for children with disabilities should focus on empowering caregivers to make them feel competent and confident in meeting the needs of their child (Dunst, Leet, & Trivette, 1988) • Thus, the main goal for NEI is to provide support to caregivers so they can positively impact their child’s development • In 2001, a national research council made up of leading researchers in autism provided recommendations specifically related to providing intervention to children with autism in a book entitled, Educating Children with Autism • Table 2 provides a list of some of the recommendations made in that publication • Table 3 provides a rationale for NEI for children with ASD

7. Assess Strengths and Interests • Parents identify the child’s favorite toys, preferences in activities, and unique skills • Guide parents in identifying their child’s strengths and interests as opposed to listing deficits • Start off with an open statement such as, “Tell me about your child’s strengths and interests.” • If parents have difficulty, ask some probing questions to help guide parents • See Figure 1 for a tool to assess a child’s strengths and interests

8. Assess Present Abilities • The service provider conducts caregiver interviews to gather information on the child’s present abilities • Assess present abilities related to communication, social interaction, behavior, and cognition, and any other appropriate domain • Figure 2 provides a tool for assessing a child’s present abilities

9. Assess Caregiver Priorities • The child’s present abilities should be considered as parents select priorities for intervention • Figure 3 provides a tool that can be used for assessing caregiver priorities • Parents may have several priorities in a particular domain, or they may have none at all • Check boxes are provided in the assessment tool to help organize which priorities will be targeted at the present time • Help caregivers in making reasonable commitments

10. Assess Daily Routines and Activities • Caregiver provides a list of home and community routines in which their child currently participates or may participate • School staff members list school routines and activities • Caregiver selects routines and activities for intervention (assist in making reasonable commitments) • The goal is to select routines that have the potential to address caregiver priorities and occur often enough to provide multiple learning opportunities for the child • Figure 4 can be used to record the child’s routines and activities that occur across home, community, and school contexts

11. Conduct Observations • Begin by observing parent-child interactions during the routines and activities selected for intervention • This provides an opportunity to see what supports the caregiver may already be using and assess the child’s current participation in the routine or activity • The service provider observes the child’s responsiveness to attempts made by caregivers and gathers additional information about the child’s present abilities across the communication, social interaction, cognition, and behavioral domains • The service provider may also choose to interact directly with the child to further assess present abilities and test out the child’s responses to various intervention strategies • Figure 5 provides a tool that can be used to assess the child’s current participation and possibilities for intervention for each routine or activity selected

12. Set Goals • Goals should address the child’s strengths and interests, caregiver priorities, and be based on the child’s present abilities reported by the parent and observed by the service provider • All goals should be functional and developmentally appropriate and be observable, measurable, and contain criteria for mastery • While goals are typically created based on a deficit, it is important to build upon the child’s strengths and address the child’s interests to increase participation and motivation • Table 4 provides examples of goals across the four domains

13. Provide Training and Coaching • Parent training that uses a traditional “sit and get” method of disseminating information alone is not enough to empower caregivers to implement quality intervention • Service providers must also use conferencing, modeling, and coaching • Schedule visits during specific routines and activities for purposes of modeling intervention procedures and providing immediate coaching • Table 5 provides a format for conducting video-stimulated recall conferences with caregivers

14. Collect and Analyze Data • For each goal selected, data collection procedures should be set forth • It is important to choose data collection methods that caregivers are likely to implement (ex. levels of independence ratings, lists) • Service providers should also collect some objective data in the form of probes on a periodic basis that can be used in the data-based decision making process along with the data collected by caregivers

15. Continuous Data-Based Decision Making • Service providers should continually be responding to the data being collected • If progress is not being made, the following questions should be asked: • Are the teaching procedures being implemented correctly? • Do the teaching procedures need to be altered or changed? • Does the goal need to be changed?

16. References • Dunst, C.J., Hamby, D., Trivette, C.M., Raab, M., & Bruder, M.B. (2000). Everyday family and community life and children’s naturally occurring learning opportunities. Journal of Early Intervention, 23, 151-164. • Dunst, C. J., Leet, H. E., & Trivette, C. M. (1988). Family resources, personal well-being, and early intervention. Journal of Special Education, 22, 108-116. • Kashinath, S., Woods, J., & Goldstein, H. (2006). Enhancing generalized teaching strategy use in daily routines by parents of children with autism. Journal of Speech, Hearing, and Language Research, 49, 466-485. • McWilliam, R. A. (1999). Controversial practices: The need for reacculturation of early intervention fields. Topics in Early Childhood Special Education, 19(3), 189-193. • National Research Council. (2001). Educating children with autism. Committee on Educational Interventions for Children with Autism. Division of Behavioral and Social Sciences and Education. Washington, DC: National Academy Press. • Raab, M, & Dunst, C (2004). Early intervention practitioner approaches to natural environment interventions. Journal of Early Intervention, 27(1), 15-26. • Tomlin, A.M. (2002). Partnering with parents with personality disorders: Effective strategies for early intervention providers. Infants and Young Children, 14(4), 68-75.